Pulmonary Artery Coil: Unexpected Expectorated Foreign Body

SESSION TITLE: Bronchology SESSION TYPE: Case Report Slide PRESENTED ON: Sunday, April 17, 2016 at 02:15 PM - 03:45 PM INTRODUCTION: Pulmonary artery aneurysm (PAA) is a rare anomaly that has many etiologies. The most serious complication of PAA is fatal hemoptysis resulting from its rupture.1 There is no guidelines for optimal management. However, surgical management may be recommended.2 Transcatheter embolization with coils is an effective and safe method for control of hemoptysis with non-significant complications.1 However, serious complications may occur. We report a case of right pulmonary artery aneurysm treated with coil embolization followed by endobronchial migration of the coil and coughing it out. CASE PRESENTATION: A 38-years-old female, admitted in August 2014 to Mansoura university hospital with recurrent attacks of massive hemoptysis 2 months before admission. Chest X-ray, and non-contrast chest computed tomography (CT) revealed a homogenous opacity in the right lower lobe 10 cm X 11cm giving impression of mass lesion. Fiber-Optic bronchoscopy was performed with no endobronchial abnormalities. Post contrast CT chest revealed giant right PAA occupying most of the right lower lobe with thrombosed wall (Fig 1) and transferred for further management. Coil embolization was performed with successful control of hemoptysis. Six months later, she re-presented to ER with fever, massive hemoptysis, and coughing of one of the embolized coils. Urgent pulmonary CT angiography revealed presence of unfolded coils in the right main bronchus and trachea (Fig 2). She urgently referred to OR, right lower lobectomy was performed and complicated with severe intra-operative bleeding and post-operative hypovolemic shock. She received IV fluids and blood but unfortunately 4 days later she arrested and CPR was done but failed. DISCUSSION: Coughing of embolized coil from PAA is very infrequent complication. A search of MEDLINE database revealed only one case reported by Abad and colleagues, 1990. They performed a stainless steel coil embolization of bilateral PAA; and after an initial period of success for 6 weeks, endobronchial coil migration was found during control bronchoscope and required surgical intervention. Right lower lobectomy done and patient remained free of symptoms 9 months post-operative.3 Infection and local erosion of the adjacent bronchus and probably thin wall of the aneurysm are suggested theories to explain the mechanisms of endobronchial coil migration and expelling it out. CONCLUSIONS: Coil embolization can be performed in PAA to control hemoptysis. However, endobronchial migration may occur with fatal outcome. Reference #1: Pelage JP, El Hajjam M, Lagrange C, et al. Pulmonary Artery Interventions: An Overview. RadioGraphics 2005;25:1653-1667. Reference #2: Vistarini N, Aubert S, Gandjbakhch I, et al. Surgical treatment of a pulmonary artery aneurysm. Eur J Cardiothorac Surg 2007;31:1139-1141. Reference #3: Abad J, Villar R, Parga G, et al. Bronchial migration of pulmonary arterial coil. Cardiovasc Intervent Radiol. 1990;13(6):345-346. DISCLOSURE: The following authors have nothing to disclose: Mahmoud Elhusseiny, Amro Moawad, Dina AbdAlla, Talal Amer No Product/Research Disclosure Information